o Childs ribs more horizontal than rounded less able to expand chest volume

O childs ribs more horizontal than rounded less able

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o Child’s ribs more horizontal than rounded; less able to expand chest volume Must rely more on diaphragm to compensate for changes in demands on breathing o Lung tissue is much more fragile
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Higher incidence of pulmonary contusion w blunt chest trauma Higher incidence of pneumothorax w PPV o Chest moves minimally w respiration in healthy child (immaturity/flexibility of ribs) NORMAL for abdomen to rise/fall w ventilation o Chest muscles are underdeveloped and used more as accessory muscles Leads to early retractions in respiratory distress; intercostal retractions seen in mild distress; suprasternal, supraclavicular, and sternal retractions = more severe o Compliant chest wall, smaller airways, and diaphragm dependence mean infant’s lungs are prone to collapse o Infants “grunt” to try to keep airways/lung units open when swelling/increased secretions Close off vocal cords (laryngeal braking) and bear down abdominally at end of inspiration to try to restore/maintain positive pressure and prevent collapse Respiratory system: o Breathing is inadequate when RR ≥ 60 breaths/min in children o Infants might have episodes of apnea in response to stress o Infants/children < 5 breathe at a rate 2-3x faster than adult patient Breaths also shallower (less volume/pressure required to ventilate) o Muscles of diaphragm (primary muscle of respiration) in infant prone to fatigue Working to breathe = costly; infant typically too lethargic to respond appropriately (signifies extremely ill infant; needs advanced care immediately) Cardiovascular system: o HR increases in response to fear, fever, anxiety, hypoxia, activity, and hypovolemia o In infants/children, bradycardia = late response to hypoxia; in newborns, bradycardia = initial response to hypoxia o Infants/children have smaller circulating blood volumes than adults; smaller amount of blood loss considered major hemorrhage (must stop bleeding ASAP) o Hypotension does not usually develop in infants/children until > 30% of blood volume lost Onset of hypotension is sudden when compensation fails o Infants/young children have limited ability to increase strength of cardiac contraction Cardiac compensation primarily consists of changes in HR and increase in degree of peripheral vasoconstriction Abdomen: o Child’s abdominal musculature less developed than adult’s; increased likelihood of internal organ damage w blunt abdominal trauma o Liver/spleen are more exposed and less protected by ribs/abdominal cavity until child reaches puberty (greater likelihood of injury) Extremities: o Bones of extremities fracture more often by bending and splintering (greenstick fracture) o Infant/young child’s motor development occurs from head to toes Lack of coordination leads to frequent injury from falls Metabolic rate: o Infants/children have much faster metabolic rate (2-3x faster than adults) Apnea, hypoventilation, or poor oxygenation can be more dangerous o
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  • Fall '19
  • Paul Palmiotto

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